Provider Demographics
NPI:1407597578
Name:NELSON, TAYLOR (LAC, DACM)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 ROBIN HOOD RD SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-3417
Mailing Address - Country:US
Mailing Address - Phone:540-798-2543
Mailing Address - Fax:
Practice Address - Street 1:4800 PLEASANT HILL DR STE 203
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3406
Practice Address - Country:US
Practice Address - Phone:540-798-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist